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ISSN (Print): 2359-4802 | ISSN (Online): 2359-5647

Edition: 26.6 - 13 Article(s)

Editorial

The Brazilian Journal of Cardiology at internet speed - the balance of the biennium 2012-2013

A Revista Brasileira de Cardiologia na velocidade da internet - balanço do biênio 2012-2013

Wolney de Andrade Martins

Rev Bras Cardiol. 2013;26(6):420-421

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Point of View

Dual blockade of the renin angiotensin aldosterone system: is there still room?

Duplo-bloqueio do sistema renina-angiotensina-aldosterona: ainda há espaço?

Erika Maria Gonçalves Campana; Rafael Almeida Faria; Andréa Araujo Brandão

Rev Bras Cardiol. 2013;26(6):422-425

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The authors evaluate the use of the dual blockade of the renin angiotensin aldosterone system (RAAS) in hypertension, nephropathy, heart failure and ischemic heart disease. Based on the results of clinical trials, medical guidelines do not recommend the use of this strategy in general cardiology practice, but only in special situations such as resistant hypertension, nephropathy with significant proteinuria and selected cases of heart failure. Currently, rational combinations of each of the available RAAS blockers with other classes of antihypertensive drugs are more recommended.


Keywords: Renin-angiotensin system; Kidney diseases; Heart diseases

Original Article

Neck circumference, cardiovascular disease risk factors and food consumption

Circunferência do pescoço, fatores de risco para doenças cardiovasculares e consumo alimentar

Vanessa Frizon; Camile Boscaini

Rev Bras Cardiol. 2013;26(6):426-434

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BACKGROUND: Anthropometric indicators such as BMI (Body Mass Index), WC (Waist Circumference), WHR (Waist-Hip Ratio) and more recently NC (Neck Circumference), have been used to identify obesity and overweight, with these indicators being correlated with metabolic syndrome.
OBJECTIVE: To ascertain associations among NC, CVD (cardiovascular disease) risk factors and food consumption among adults.
METHODS: Cross-sectional study of 155 male and female adults between 20 and 60 years old waiting for medical, dental, psychological or nutritional consultations at a Health Care Unit, who underwent social, economic, anthropometric and nutritional assessments.
RESULTS: 155 people were analyzed: 71% females, with an average age of 38.0±12.1 years old, 70.3% with partners; 36.8% did not complete their basic schooling and 84.5 % were wage earners. Hypertension was noted in 22.6%, diabetes in 5.2% and dyslipidemias in 20.0% of the sample. Increased NC was found in 54.8% of the sample, with high and very high WHR in 61.3%. People with increased NC presented significantly higher consumption of proteins (p=0.003), lipids (p=0.008), saturated fat (p=0.011), polyunsaturated fat (p=0.008) and monounsaturated fat (p=0.001) than the group with normal NC, as well as higher rates of hypertension (p=0.015), diabetes (p=0.008), dyslipidemias (p=0.002), obesity (p<0.001), very large WC (p<0.001) and very high WHR (p=0.008).
CONCLUSIONS: People with increased NC presented higher rates of hypertension, diabetes, dyslipidemias and obesity, associated significantly with food consumption.


Keywords: Anthropometry; Cardiovascular diseases; Obesity

Effect of resistance training on cardiovascular parameters in normotensive and hypertensive adults

Efeito do treinamento resistido em parâmetros cardiovasculares de adultos normotensos e hipertensos

Caroline Brand; Luciana Caye Griebeler; Maria Amélia Roth; Fábio Fernandes Mello; Temístocles Vicente Pereira Barros; Letícia Daiani Neu

Rev Bras Cardiol. 2013;26(6):435-441

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BACKGROUND: Although the use of resistance training (RT) as therapy for the hypertensive population is still poorly investigated, the literature nevertheless indicates the beneficial effects of this training on the cardiovascular system. But there are still only a few studies assessing cardiovascular adaptations - such as the cardiac structure and its functions - in the hypertensive population after a prolonged period of RT.
OBJECTIVE: To analyze the effect of 48 weeks of resistance training (RT) on the diastolic diameter (LVEDD), systolic diameter (LVSD), left ventricular mass (LVM), ejection fraction (EF) and hemodynamic parameters in controlled hypertensive and normotensive subjects.
METHODS: 15 subjects were divided into two groups: hypertensive (GH, n=8) and normotensive (GN, n=7). Both groups performed RT for a period of 48 weeks. The anthropometric, hemodynamic and cardiovascular parameters were evaluated.
RESULTS: The LVDD and LVSD cardiovascular parameters, and the EF and LVM of both groups are compliant with the reference values. The GH LVM and EF levels decreased favorably pre- to post-test.
CONCLUSION: Long-duration resistance training is effective as a control therapy, as no changes were noted in hypertension levels, with no adverse effects presented during the training sessions.


Keywords: Hypertension; Exercise; Cardiovascular system

Metabolic syndrome and other risk factors for cardiovascular disease in an obese population

Síndrome metabólica e outros fatores de risco para doença cardiovascular em população de obesos

Hilda Carla Moura dos Santos; Luciana Gonçalves de Orange; Cybelle Rolim de Lima; Maria Magdala Sales de Azevedo; Keila Fernandes Dourado; Sheylane Pereira de Andrade

Rev Bras Cardiol. 2013;26(6):442-449

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BACKGROUND: Metabolic syndrome (MS) is characterized by the loss of body homeostasis related mainly to abdominal obesity that is associated with lipid profile alterations, increased blood pressure and hyperinsulinemia, which are factors stepping up the risk of type 2 diabetes mellitus (DM2), cardiovascular disease and insulin resistance. Adherence to exercise and a healthy eating plan are vital for treating this syndrome.
OBJECTIVE: To ascertain the prevalence of metabolic syndrome (MS) and other risk factors for cardiovascular diseases (CVD) in obese patients.
METHODS: Cross-sectional study of 293 obese patients monitored at a nutrition outpatient clinic. MS was defined on the basis of the NCEP-ATP III.
RESULTS: Among the 44 men and 249 women evaluated, 67.7% had MS, with no significant difference between genders, but more frequent among the elderly. The most prevalent comorbidities were dyslipidemia (69.1%), systemic hypertension (49.0%) and diabetes mellitus or glucose intolerance (36.3%). Patients with MS presented higher rates for other CVD indicators (TG/HDL ratio, waist/height ratio, LDL and TC).
CONCLUSION: The prevalence of MS was high, associated with several other comorbidities and CVD indicators.


Keywords: Obesity; Cardiovascular diseases; Metabolic syndrome X

Comparison of heart rate variability between young smokers and non-smokers

Comparação entre a variabilidade da frequência cardíaca de jovens tabagistas e não tabagistas

Maria de Fátima Amaral; Mariana Lacerda e Silva; Tatiane Ribeiro Pinto; Bruno Porto Pessoa; Pedro Henrique Scheidt Figueiredo; Gisele do Carmo Leite Machado Diniz

Rev Bras Cardiol. 2013;26(6):450-456

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BACKGROUND: Changes in cardiac autonomic modulation may appear early among smokers.
OBJECTIVE: To compare heart rate variability (HRV) at rest among young smokers and non-smokers, and cardiac autonomic modulation during the Valsalva maneuver (VM).
METHODS: 37 healthy subjects were studied, aged 20.6±3.6 years old (18 smokers and 19 nonsmokers). The HRV was recorded in two stages: at rest and during VM. HRV rates were evaluated by time (rMSSD and PNN50) and frequency (HF, LF and LF/HF). The effect of the MV on autonomic modulation was evaluated by the relative variation in the HRV rates.
RESULTS: Lower rMSSD (p=0.011) and pNN50 (p=0.010) values were observed at rest in the smokers group, while resting heart frequency was significantly lower in the non-smoker group (p=0.035). There were no significant differences between the groups for other variables at rest, nor any differences in the relative variation of the HRV rates induced by MV.
CONCLUSIONS: Smoking causes changes in cardiac autonomic modulation among young people, characterized by reduced parasympathetic responses at rest.


Keywords: Smoking; Autonomic nervous system; Valsalva maneuver

Primary percutaneous coronary intervention in diabetic and non-diabetic patients: outcomes and progress

Intervenção coronariana percutânea primária em pacientes diabéticos e não diabéticos: resultados e evolução

Rodrigo Trajano Sandoval Peixoto; Edison Carvalho Sandoval Peixoto; Angelo Leoni Tedeschi; Marcello Augustus de Sena; Bernardo Kremer Diniz Gonçalves; Claudio Buarque Benchimol; Glaucia Maria Moraes Oliveira

Rev Bras Cardiol. 2013;26(6):457-464

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BACKGROUND: Studies have shown poorer progress among patients with Diabetes Mellitus (DM) after primary percutaneous coronary intervention (PPCI).
OBJECTIVE: To compare mortality rates and major events (ME) at 30 days and 1 year among diabetic and non-diabetic patients treated with PPCI.
METHODS: Prospective study of 450 consecutive patients (121 diabetics and 329 non-diabetics) with ST-segment elevation acute myocardial infarction in the first 12 hours of progress, using balloon or conventional stents and without cardiogenic shock.
RESULTS: Diabetic and non-diabetic patients were similar in terms of age (63.1±10.0% x 62.3±11.7%, p=0.44), male (63.6% x 69.9%, p=0.20) and multivascular coronary disease (66.1% x 60.8%, p=0.30) respectively. Diabetics presented more dyslipidemia (65.3% x 51.7%, p=0.01) and severe left ventricle dysfunction (15.7% x 8.2%, p=0.02). The stent implantation rate (83.5% x 81.1%, p=0.86), glycoprotein (GP) IIb/IIIa inhibitor use (79.3% x 82.2%, p=0.83), mortality at 30 days (2.5% x 2.7%, p=1.00) and at 1 year (5.0% x 6.7%, p=0.65) and ME at 30 days (4.1% x 6.4%, p=0.49) and at 1 year (19.4% x 15.4%, p=0.34) were similar in diabetic and non-diabetic patients respectively.
CONCLUSIONS: Diabetic patients undergoing PPCI posted ME and mortality rates similar to non-diabetic patients at 30 days and 1 year, predicting in-hospital non-success at 30 days and 1 year, with an age of > 65 years at 1 year. Multivascular coronary disease was an ME predictor at 30 days and 1 year.


Keywords: Myocardial infarction; Diabetes mellitus; Angioplasty

Subclinical inflammation in women taking oral contraceptives

Inflamação subclínica em mulheres que utilizam contraceptivo oral

Jefferson Petto; Leandro Silva Pereira; Alan Carlos Nery dos Santos; Beatriz de Almeida Giesta; Thiago Araújo de Melo; Ana Marice Teixeira Ladeia

Rev Bras Cardiol. 2013;26(6):465-471

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BACKGROUND: Recent studies show that women taking oral contraceptives (OC) have higher triglyceride and low-density lipoprotein levels than women not taking CO. Although the long-term clinical consequences of this increase are still unknown, studies suggest that higher levels of low-density lipoproteins contribute directly to vascular inflammation. One of the most effective ways of measuring vascular inflammation is through high sensitivity C-reactive protein (CRP).
OBJECTIVE: To examine whether the CRP levels of women taking OC are higher than those of women not taking OC.
METHODS: Study conducted at the Bahia Social Work College, Salvador, Bahia State - Brazil between July and December 2012, including apparently healthy women between 18 and 28 years old, eutrophic, classified as irregularly active and with fasting triglycerides below 150mg/dL. The sample was divided into two groups: an NOC group of women who not taking any type of hormone-based contraceptive and an OC group of women taking continuous low-dose OC for at least one year. After fasting for 12 hours, 5mL of blood were collected to measure their CRP levels.
RESULTS: 44 women were selected and divided equally between the groups, aged 24.0±2.9, BMI 21.0±3.2kg/m2. The median and interquartile CRP deviations in the NOC group and the OC group were respectively 0.5mg/L (0.0 to 0.9) and 2.1mg/L (0.9 to 3.2), with a statistically significant difference (p=0.002).
CONCLUSION: In this study, the CRP levels of women taking oral contraceptives were significantly higher than those of women not taking oral contraceptives.


Keywords: Coronary artery disease; Dyslipidemias; Lipoproteins; Contraceptive agents; Inflammation

Comparison of pulse pressure values in controlled and uncontrolled hypertensive patients

Comparação entre os valores da pressão de pulso em hipertensos controlados e não controlados

Bruno Bordin Pelazza

Rev Bras Cardiol. 2013;26(6):472-480

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BACKGROUND: Central blood pressure reflects left ventricle overload conditions more accurately than brachial artery measurements in hypertensive patients.
OBJECTIVE: To compare pulse pressure (PP) at the aortic root with that obtained indirectly in the brachial artery in controlled (CTL) and uncontrolled (NCTL) hypertensive patients.
METHODS: This is a cross-sectional study of patients admitted electively for coronary angiography between 2009 and 2012, divided into two groups: CTL with blood pressure (BP) values of <140×90 mmHg (n=110) and NCTL with BP values of >140×90 mmHg, taking oral antihypertensive medications (n=120).
RESULTS: For both the CTL and NCTL groups, systolic blood pressure and PP variables were significant from 50 years of age onwards. In this study, 52.0±6.0% of the patients were in the NCLT group, suggesting that large numbers of people are still exposed to serious diseases such as stroke, and coronary artery disease.
CONCLUSION: With aging, particularly from 50 years of age onwards, the SBP and PP measured directly at the root of the aorta are higher than the respective pressures measured indirectly in the brachial artery. If based solely on the levels obtained in the brachial artery, diagnosis and control of hypertension may be delayed by at least a decade.


Keywords: Hypertension; Blood pressure; Vascular stiffness; Cardiovascular diseases

Case Report

Takotsubo cardiomyopathy in octogenarian

Cardiomiopatia de takotsubo em octogenária

Antônio Welington da Silva; Lúcia de Sousa Belém; Francisco Eduardo Siqueira da Rocha; Hilton Aguiar Canuto; Antônio Daniel Leite Simão; Victor Hugo Lauro Soares

Rev Bras Cardiol. 2013;26(6):481-484

Abstract PDF PORT

Female, 88 years old, admitted to the Emergency Department in distress after a heated family discussion, with high intensity retrosternal typical anginal pain lasting more than 30 minutes, associated with moderate sweating, dyspnea, nausea and fainting, with ST-segment elevation in the electrocardiogram. Patient initially treated as an acute myocardial infarction with ST-segment elevation. Cinecoronary angiography showed an absence of coronary artery lesion with the anterior wall ballooning like a dumbbell, diagnosed as Takotsubo cardiomyopathy.


Keywords: Takotsubo cardiomyopathy; Psychological stress; Myocardial ischemia; Left ventricular dysfunction

Use of beta-blockers in cardiogenic shock due to takotsubo cardiomyopathy

Uso de betabloqueador no choque cardiogênico da cardiomiopatia de takotsubo

Ana Filipa Caldeira Damásio; Carlos Alberto Dias Cotrim; Maria José Pereira Campos de Frias Loureiro; Inês Maria Rosário Cruz; Daniel Gomes Caldeira; Hélder Horta Pereira

Rev Bras Cardiol. 2013;26(6):485-488

Abstract PDF PORT

Takotsubo cardiomyopathy is characterized by reversible changes in the systolic and segmental left ventricular function associated with normal coronariography. The shock associated with this cardiomyopathy is caused by left ventricular systolic dysfunction and/or dynamic left ventricular outflow tract obstruction. Identification of the etiology of the shock has implications for treatment. This case study reports on a 76-year-old women diagnosed with Takotsubo cardiomyopathy whose presentation mimicked an acute myocardial infarction complicated by cardiogenic shock. The shock was reversed after intravenous administration of propanolol.


Keywords: Takotsubo cardiomyopathy; Cardiogenic shock; Mitral valve; Adrenergic beta-antagonists

Review Article

Role of the nurse for monitoring central blood pressure among hypertensive patients by applanation tonometry

O enfermeiro no monitoramento da pressão central dos hipertensos através da tonometria de aplanação

Bruno Bordin Pelazza

Rev Bras Cardiol. 2013;26(6):489-495

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When based solely on brachial blood pressure (BBP) levels measured through indirect (oscillometric and/or auscultatory) methods, diagnosis and control of hypertension may be delayed by at least a decade, adversely affecting the start of treatment. Patients with high central blood pressure (CBP) and normal BBP may be identified by nurses as normotensive, thus underestimating their cardiovascular risks. Incorrect diagnoses may lead to abusive or indiscriminate use of antihypertensive medications, exposing patients to severe side effects that undermine their quality of life. Clinical trials have demonstrated that CBP is a better predictor of future cardiovascular risk than BBP. CBP measurements obtained through applanation tonometry (AT), which is a fairly modern noninvasive method, are more trustworthy, lessening cardiac complications and risks of infection. This portable device is easy to handle. The researched studies indicate AT as the best method for assessing and controlling CBP. Further studies are needed, exploring the use of this diagnostic tool in the Brazilian population.


Keywords: Hypertension; Blood pressure; Vascular stiffness; Nursing care; Patient care; Blood pressure monitors

Agradecimento aos revisores

Revista Brasileira de Cardiologia

Rev Bras Cardiol. 2013;26(6):496

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